Symposium i.v.m. aandoeningen van het axiaal skelet UZ Leuven campus Gasthuisberg 24 november 2012 Osteoporotische indeukingsfracturen Steven Boonen, MD, PhD Centrum voor Metabole Botziekten UZ Leuven K.U.Leuven 2010
Osteoporotic Vertebral Fractures Hp Ha Hp Ha One of three measurements 15% lower than comparable measurement at adjacent vertebral body Genant et al. JBMR 1993; 8(9): 1137-48
The Osteoporosis Continuum Healthy Spine 50 Menopausal Experiencing vasomotor symptoms 55+ Postmenopausal At greater risk for vertebral fracture than any other type of fracture 75+ Elderly At risk for hip fracture and other types of nonvertebral fracture Kyphotic spine
Incidence (per 100,000 per year) Age-Specific Rates of Selected Fractures Vertebrae Hip Colles Age (years) Chrischillies et al. Arch Intern Med 1991; 151: 2026-32 Cooper et al. Trends Endocrinol Metab 1992; 3: 224-229
Progression of Osteoporosis in Untreated Patient With Vertebral Fractures
Percent (%) of patients The Risk for New Fractures After a Vertebral Fracture Increases Within One Year 30 25 20 15 10 5 19.2% 26.1% 0 1 in 5 postmenopausal women will have another vertebral fracture within a year 1 in 4 postmenopausal women will have any other osteoporotic fracture within a year Lindsay et al. JAMA 2001; 285: 320-23 Lindsay et al. JBMR 2001; 16(S1): 294
The Vertebral Fracture Cascade
Women (%) with incident vertebral fractures Risk of New Vertebral Fractures According to Number of Existing Vertebral Fractures 25 P<0.05 20 P<0.05 15 10 5 0 0 1 2 Number of prevalent vertebral fractures Marcus et al, J Bone Miner Res 2003; 18:18-23
Mean OPAQ Score Decline in Quality of Life According to Number of Existing Vertebral Fractures Women with vertebral fractures suffer declines in all domains of the SF36 95 90 85 80 75 70 65 60 65 60 Physical function P<0.001 Emotional status P<0.001 Clinical symptoms P<0.001 Overall HRQOL P<0.001 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
Impact of Recurrent Vertebral Fractures Loss of height Kyphosis Chronic back pain Reduced pulmonary function Loss of quality of life Impact on activities of daily living
Reducing Fracture Risk: Indications for Osteoporosis Treatment (on Top of Calcium and Vitamin D) Older individuals with existing vertebral fracture(s), to prevent recurrent fractures Older individuals with documented osteoporosis (T-score below -2.5 at the hip or lumbar spine), even without previous fracture(s), to prevent first osteoporotic fracture
Patients (%) Vertebral Fracture Risk Reduction With Osteoporosis Medication in Postmenopausal Osteoporosis Over 1 year Over 3 years 30 RR: - 49% 32.8% RR: - 41% 25 P < 0.001 20 15 10 12.2% P < 0.001 20.9% Placebo Strontium 2 g/d 5 0 6.4% N = 1649 RR= 0.51; 95% CI [0.36; 0.75] RR= 0.59; 95% CI [0.48; 0.73] N Engl J Med 2004; 350: 459-468
Meunier PJ, Roux C, Seeman E et al. N Engl J Med. 2004 ; 350:459-68. Proportion of Patients with Height Loss During Osteoporosis Treatment Over 3 years Patients (%) 40 35 30 25 20 15 10 5 0 Placebo RR: - 20% P = 0.003 Strontium ranelate 2 g/d Height loss > 1 cm
Beneficial Effects of Osteoporosis Treatment on Quality of Life Over 3 years Over 4 years Absolute change in score between baseline and end-point 1 0 P = 0.016 P = 0.02 ITT under treatment - 1-2 N =1240 N =1250 Strontium ranelate 2g/day Qualiost Total Score (Physical Score & Emotional Score) Placebo Marquis P et al. Osteoporos Int. 2005;16(suppl3):S54;P223. Marquis P, et al.osteoporos. Int. 2007;18(suppl 1):S123 (P296).
% Patients With New Vertebral Fracture Vertebral Fracture Risk Reduction With Osteoporosis Medication in Postmenopausal Osteoporosis 15 Placebo Zoledronic acid 5 mg RR=70% P < 0.001 10 RR=71% P < 0.001 10.9% 5 RR=60% P < 0.001 7.7% 0 3.7% 2.2% 1.5% 0 1 0 2 0 3 3.3% Years Black DM, et al. N Engl J Med. 2007;356:1809-1822.
Balloon Kyphoplasty VCF before and after treatment Percutaneous placement of inflatable balloon into the vertebral body Inflation of the balloon compacts the cancellous bone and pushes the endplates apart After balloon removal, the resulting void is filled with viscous bone cement (polymethylmethacrylate)
Symposium i.v.m. aandoeningen van het axiaal skelet UZ Leuven campus Gasthuisberg 24 november 2012 Osteoporotische indeukingsfracturen Steven Boonen, MD, PhD Centrum voor Metabole Botziekten UZ Leuven K.U.Leuven 2010
Zorgprogrammagedreven en kwaliteitsgerichte geneeskunde
Zorgprogramma metabole botziekten Leeftijd: 21 jaar of ouder Consultatieve evaluatie mogelijk: al dan niet opgenomen maar in staat tot consultatieve evaluatie Diagnostische en/of therapeutische adviesnood i.v.m. metabool botlijden: risicofactoranalyse en bepaling van absolute fractuurrisico advies in kader van vermoedelijke of bewezen osteoporose osteoporosescreening in kader van voorbeschikkende context zoals corticotherapie of hyperthyreoïdie chronische monitoring en bijsturing van osteoporosebehandeling advies in kader van vermoedelijke of gedocumenteerde niet-osteoporotische metabole botpathologie zoals osteitis deformans (m. Paget) of hyperparathyreoïdie indicatiestelling voor botbiopsiename of kyfoplastie
Centrum voor Metabole Botziekten Extern (via perifere verwijzer) Intern (tijdens of aansluitend op UZ-contact) Centrum voor Metabole Botziekten Functiemeting (DXA) E415 eenheid voor botdensitometrie Raadpleging E409 consultatie-eenheid inwendige geneeskunde Daghospitalisatie E410 medisch ambulant centrum E459 geriatrisch dagcentrum E596 chirurgisch dagcentrum
Overzicht van de organisatie van het zorgprogramma metabole botziekten Locatie: uiteenlopende zorgeenheden binnen UZ in functie van contacttype eenheid voor botdensitometrie (E415) functiemeting consultatie-eenheid inwendige geneeskunde (E409) raadpleging medisch ambulant centrum (E410) daghospitalisatie geriatrisch dagcentrum (E459) daghospitalisatie chirurgisch dagcentrum (E596) daghospitalisatie Botmeting: op eenheid voor botdensitometrie (E415) na telefonische afspraak via 016/344822 Raadpleging: op consultatie-eenheid inwendige geneeskunde (E409) na telefonische afspraak via 016/344822